Panic Attacks: Nature, Types, and Symptoms

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This is part one of a four part series on panic attacks.

Panic attacks are disconnected episodes of intense fear. They begin abruptly and reach their peak in 5-10 minutes.

One in five people experience panic attacks at some point in their lives. That is over 65 million people in US alone.

If you have experienced panic attacks before, you know that they can feel very uncomfortable and unpleasant.

For those who have no experience with panic, let me give you an example of what an episode of panic can feel like. The example comes from an actual patient. Pay special attention to the underlined symptoms:

I was 25 when I had my first attack….One night I went to sleep and I woke up a few hours later—I’m not sure how long—but I woke up with this vague feeling of apprehension. Mostly I remember how my heart started pounding. And my chest hurt...I was so scared. I was sure that I was dying—that I was having a heart attack. And I felt kind of queer, as if I were detached from the experience. It seemed like my bedroom was covered with a haze. I ran to my sister’s room, but I felt like I was a puppet or a robot who was under the control of somebody else while I was running. I think I scared her almost as much as I was frightened myself. She called an ambulance.¹

Panic attacks are typically associated with palpitations (pounding heart), sweating, shaking, shortness of breath, nausea, hot and cold spells, feeling lightheaded and dizzy, fears of going crazy or dying, derealization and depersonalization.

Derealization refers to the perception of one’s surrounding as dreamy and unreal (e.g., the haze-covered bedroom, from the above example). Depersonalization refers to detachment from one’s body (e.g., feeling like a robot, from the example).

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Because of the accompanying chest pain and accelerated heartbeat, many people who experience panic attacks fear that they are having a heart attack; a result some rush to the emergency room (ER).²

Management

Medical check-up

First, ensure that no medical condition is responsible for the panic attacks.

The use or withdrawal from certain medications or drugs, asthma, thyroid problems, and other conditions can cause—or be mistaken for—panic attacks.

It would also be helpful to see a mental health professional, to make sure that the attacks are not part of a diagnosable medical or psychiatric illness. Indeed, panic attacks can occur in a number of mental disorders, such as social anxiety disorder, specific phobias, post-traumatic stress disorder, etc.

If there is an underlying medical or psychiatric condition, the proper medication and/or psychotherapy aimed at treating the condition can help control the panic attacks too.

Learning about panic

Let us now talk about the nature of panic a little more. During a panic attack, one is likely in the fight-or-flight mode. The fight-or-flight response is a physiological reaction that prepares the body to either fight the threat or flee the scene. This response can explain, at least in part, many of the symptoms of panic attack, as I explain below.

What happens in our body during the fight-or-flight response? Heart rate often increases in order to redistribute blood supply to the organs that will play a bigger role in managing the threat (e.g., skeletal muscles used in fighting or escaping the danger).

Breathing rate accelerates as well, so that lungs can supply the additional demand for oxygen (as required by organs that are now more active).

Energy use is also increased; burning this energy produces heat, so the the body perspires in order to cool down.

Meanwhile, bodily functions that are not immediately useful (e.g., reproductive and digestive functions) are suppressed. That may explain why we feel the urge to empty our bladder/bowels when we are very afraid.

There are different kinds of panic attacks. An expected panic attack refers to a panic attack that occurs in situations previously known to cause anxiety. If you are socially anxious and are unexpectedly asked to dance by a stranger at a party, you might get a panic attack. One common response to such an expected panic attack, is to flee the scene.

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Of course, fleeing the scene may not be an option (e.g., if you are attending a mandatory work meeting and have a panic attack). Fleeing may also not be a good solution if you have an unexpected panic attack. In an unexpected panic attack (as often occurs in panic disorder), one is unable to point to a particular cue for the panic.

Let’s say you are at work, putting the finishing touches on a project, and suddenly feelings of panic come over you. You tremble with anxiety and perspire heavily. What caused the panic? You do not know.

Perhaps that explains why some people with panic disorder fear that they might be going crazy or dying. They experience tremendous fear and yet can not find the source of that fear anywhere. They can not make sense of their body’s severe reaction.

Regardless of which type of panic you are experiencing, neither fight nor flight work. They prolong and intensify the current or future episodes. So what to do?

You might want to try leaning into the attack. Yes, lean into it.

I know this sounds counterintuitive. As a friend once said, this is like being asked to put your head in the mouth of a hungry alligator.

It is true, this goes against our nature, against how we solve most other problems.

So why do it? And how?

I will answer the first question in my next post, by using a few metaphors to help explain how to think of panic attacks. Then in my last post in the series, I will explain how to lean into panic.